MyCare Client Funding Claims (NDIS) module
The National Disability Insurance Scheme (NDIS) has put increasing financial pressure on disability providers through its ‘payment in arrears’ funding model and admin heavy claiming process. This has resulted in higher administrative costs and cash flow challenges for many providers operating in the NDIS. Late, incorrect, or failed payments have resulted in delayed or even unpaid claims by the NDIA. According to the NDS there are hundreds of millions of dollars in unpaid claims to Providers in Australia.
Streamlining NDIS operations and simplified NDIA claiming
In response to the strain on providers and participants in dealing with NDIA claims, the NDIA has been working with software aggregators, like LanternPay (part of HICAPS, a NAB company), to enable digital connectivity between the NDIA data and systems and software vendors like us with the end goal to synchronise data, automate transaction processing, streamline administration, and ultimately improve the NDIS experience for both providers and participants.
Via LanternPay, MyCare’s NDIA Registered Providers can now take full advantage of the functionality enabled by the NDIA’s Application Programming Interfaces (APIs) to access data and streamline claiming against NDIA managed participants
NDIA’s API connection is a game changer to synchronise data,
simplify claiming and improve cash flow.
The LanternPay integration enables
1) Service Bookings to be created in MyCare and pushed out directly to the NDIA system
2) Providers to submit Claims directly to the NDIA system from MyCare and receive instant responses – no need to use the time-consuming NDIS portal.
3) Service Bookings, Claims and Payments to be synchronized with the NDIA system, allowing MyCare users to receive instant updates when there are changes in Service Bookings and as Claims are processed by the NDIA.
So what does this mean for set up and data records?
MyCare users can choose multiple options when setting up client funding. Where a Service Booking already exists in the NDIA system, MyCare will retrieve these with a few simple steps. If a new Service Booking is required, client funding can be set up easily in MyCare or the NDIA portal in accordance with the Service Agreement. Both can be synchronised and updated.
MyCare also delivers transparency and a digital data record for users to meet audit requirements and help with any referred matters to the NDIS Quality and Safeguards Commission.
Here is how MyCare is streamlining administration and automating NDIS claiming processes:
Downloading existing Service Bookings from the NDIA:
- Existing Service Bookings can be downloaded directly into MyCare from the NDIA system and any updates will be automatically synchronised.
- Creating new Service Bookings from within MyCare: New Service Bookings can be either set up in the NDIA portal and downloaded into MyCare as per the process above or directly created within MyCare in accordance with the Service Agreement and pushed out to the NDIA system.
- Submitting Funding Claims and receiving instant NDIA adjudication: NDIS Funding Claims are uploaded to the NDIA system and checked instantly with a response received for each claim item. The response will indicate the claim status as being ‘in progress’, ‘approved’ or‘rejected’. Approval takes seconds and if there are no errors then the claim is ready for payment and the Service Booking balance updates automatically. Where errors are identified, an error message is received for each claim item stating the reasons for the rejection so that immediate and appropriate action can be taken by the user. A Funding Claim item can be re-submitted any time after required corrections are made.
- NDIS Funding Payments are processed daily after 6pm (overnight) by the NDIA and data updated in MyCare automatically. The payment approval response is stored in MyCare for each individual claim so users can compare what they claimed vs what NDIA has paid. Any gaps in payment can be easily identified by users for further investigation.
- Client Funding Claim Reconciliations: Claim Reconciliation can be undertaken at multiple stages of the claiming lifecycle so that users can stay in control of their cashflow. For example, MyCare supports reconciliations after NDIA responses are received for further action where necessary. MyCare makes it easy for users to compare and reconcile claim details with approvals and payment responses. Reports can be also be created to help reconcile the bank statements with the actual payment responses from the NDIA.
The LanternPay integration is the way of the future for providers as it automates and streamlines a number of previously manual and time-consuming tasks by connecting Providers directly to the NDIA data and systems:
· Service Bookings, the driving force of the NDIS funding flows, are dealt with in a streamlined and integrated way;
· Claims can be submitted directly to the NDIA from MyCare without the need for the NDIA portal;
· NDIA responses are automatically ingested and updated in MyCare with approved claims processed and paid within 24 hours by the NIDA;
· High quality data and reporting are available to track processing and enable fast and simple reconciliation
MyCare is delivering for Providers wanting to streamline administration, protect margins and reduce cashflow risk as it relates to NDIA managed participants. With MyCare providers can focus on their customers and service delivery!